Basic Information
| Provider Information | |||||||||
| NPI: | 1598188716 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC, MED | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ARCHER | ||||||||
| OtherFirstName: | TIFFANY | ||||||||
| OtherMiddleName: | LATONYA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1827 | ||||||||
| Address2: | |||||||||
| City: | MILLEDGEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310591827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784454817 | ||||||||
| FaxNumber: | 4784454963 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 BARROWS FERRY RD NE | ||||||||
| Address2: | |||||||||
| City: | MILLEDGEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310618520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784455518 | ||||||||
| FaxNumber: | 4784454963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2014 | ||||||||
| LastUpdateDate: | 01/23/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC005986 | GA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.